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首页> 外文学位 >Experiences and Perceptions of Disrespectful and Abusive Facility-based Childbirth Care in the Western Highlands of Guatemala: A Mixed Methods Analysis.
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Experiences and Perceptions of Disrespectful and Abusive Facility-based Childbirth Care in the Western Highlands of Guatemala: A Mixed Methods Analysis.

机译：危地马拉西部高地基于不尊重和虐待性设施的分娩护理的经验和看法：混合方法分析。

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摘要

Background. The present research takes place among a largely indigenous Mayan population living in rural to remote villages in the Western Highlands of Guatemala. This population has a disproportionately higher maternal mortality ratio compared to their non-indigenous counterparts and is less likely to utilize skilled childbirth care in health institutions. In addition to geographic and economic access barriers, negative perceptions of health services, specifically discrimination, poor client-provider interactions and language barriers reinforce the tradition to give birth at home.;Methods. The first manuscript is a qualitative case study that explores the contributors, manifestations, and consequences of poor maternity care quality, from the community's perspective. The analysis employs the disrespectful and abusive maternity care typology to guide a thematic analysis of thirty in-depth interviews and fifteen focus group discussions. The second manuscript uses a quantitative nested modeling approach to consider the factors associated with reporting experiences or perceptions of disrespect and abuse among a 'facility birth cohort' and separately among a 'home birth cohort'. Variables hypothesized to increase reports of disrespect and abuse and protect against disrespect and abuse are tested. The third manuscript aims to identify factors associated with future intention to give birth in a health facility, separately among members of the home and the facility cohorts. The independent variables of interest represent care-seeking determinants: access to care (geographic and financial), perceived need for maternity care, and two measures of perceived quality: satisfaction with last birth and disrespect and abuse (perceived or experienced).;Results. In manuscript one, respondents from across the study villages described (to some degree) all seven categories of disrespect and abuse. Societal, facility-level and individual-level factors were cited as contributors to disrespect and abuse. In manuscript two, eighteen percent of women who gave birth to their last child in a health facility reported experiencing at least one of three measures of disrespect and abuse. The most marginalized (indigenous, uneducated, relatively poorer with high parity) have an increased probability of reporting disrespect and abuse, but are less likely to perceive it. In manuscript three, perceived need for facility-based childbirth services and satisfaction with either last childbirth experience, at home or in a facility, are key factors associated with intention to give birth in a health institution in the future. Reporting disrespect and abuse (facility cohort) is a deterrent to seeking facility-based care in the future. Select perceptions of disrespect and abuse (home cohort) did not have an association with future intention.;Conclusion. Poor perceptions of care quality and negative client experiences are an important barrier that erode trust in a health system, contribute to delays or decisions to seek facility-based care. By extension, the former can lead to preventable cases of maternal and neonatal death and disability. This work has important implications for improving quality of care, upholding human rights and addressing disparities critical to the achievement of universal health coverage and other Sustainable Development Goals.
机译：背景。目前的研究是在危地马拉西部高地农村到偏远村庄的大部分玛雅土著居民中进行的。与非土著人口相比，这一人口的孕产妇死亡率高得多，而且在卫生机构中利用熟练的分娩护理的可能性较小。除了地理和经济上的获取障碍之外，对卫生服务的负面看法，特别是歧视，与客户/提供者之间的不良互动以及语言障碍，都加剧了在家中分娩的传统。第一份手稿是定性案例研究，从社区的角度探讨了产妇护理质量差的原因，表现形式和后果。该分析采用无礼和虐待性的孕产妇护理类型，对三十次深度访谈和十五次焦点小组讨论进行主题分析。第二份手稿使用定量嵌套建模方法来考虑与“设施出生队列”中以及“家庭出生队列”中报告对不尊重和虐待的经历或看法相关的因素。假设变量会增加对不尊重和虐待的报道，并防止不尊重和虐待。第三份手稿旨在确定与将来在医疗机构中分娩的意愿相关的因素，分别在家庭成员和机构成员中进行。所关注的独立变量代表寻求护理的决定因素：获得护理的程度（地域和经济状况），对产妇护理的感知需求以及对感知质量的两种衡量标准：对上一胎的满意程度以及对他人的不尊重和虐待（感知或经历的）。在手稿一中，来自研究村庄的受访者（在某种程度上）描述了所有七种不尊重和虐待行为。社会，设施层面和个人层面的因素被认为是造成不尊重和虐待的原因。在手稿中，有18％的妇女在医疗机构中生下了最后一个孩子，据报告，他们经历了至少三种不尊重和虐待措施中的一种。边缘化程度最高的人（土著，未受过教育，相对贫困的人具有较高的均等价）报告不尊重和虐待的可能性增加，但不太可能被感知到。在手稿三中，人们对基于设施的分娩服务的需求以及对在家中或机构中最后一次分娩经历的满意度的认识是与将来在医疗机构分娩的意愿相关的关键因素。报告不尊重和虐待（设施队列）会阻止将来寻求基于设施的护理。选择的对他人不尊重和虐待的看法（家庭队列）与未来的意图没有关联。对护理质量的不良认识以及对患者的负面体验是削弱对卫生系统信任的重要障碍，会导致延误或决定寻求基于设施的护理。通过扩展，前者可以导致孕妇和新生儿死亡和残疾的可预防病例。这项工作对提高护理质量，维护人权和解决对实现全民健康覆盖和其他可持续发展目标至关重要的差距具有重要意义。

著录项

  • 作者

    Peca, Emily Elizabeth.;

  • 作者单位

    The George Washington University.;

  • 授予单位 The George Washington University.;
  • 学科 Health sciences.
  • 学位 Dr.P.H.
  • 年度 2016
  • 页码 272 p.
  • 总页数 272
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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